WHEN BOBBI MCCAUGHEY made history by giving birth to seven living babies, one of the first questions asked was “Why?”.

As the media quickly pointed out, most women facing multiple births of four or more babies opt for a procedure called “fetal reduction,” an abortion procedure that eliminates one or more unborn babies in the hope of giving the other babies a better chance of survival.

Prematurity, the major danger of multiple pregnancies, increases the chances of death or disability in newborns. Before McCaughey, it was thought an impossibility to carry seven babies past 28 weeks, the “magic number” that gives premature infants a good chance of survival.

Multiple births used to be rare, but with the advent of new reproductive technologies, the number of pregnancies involving three or more babies has tripled since 1980. Fertility drugs such as those McCaughey used and in vitro fertilization (“test tube” babies) are primarily responsible for the tremendous increase. In vitro clinics in the United States, unlike those in most other countries, are under no laws regulating the number of embryonic babies that can be placed in a womb. The more embryos placed into a womb, the greater the chance that at least one baby will survive—and the success rate of the clinic be improved.

When multiple babies result either naturally or with technology, however, doctors usually offer or suggest fetal reduction—a procedure that is adding a new wrinkle to the abortion debate. The physical and emotional risks of fetal reduction are little explored though, in contrast to the litany of the potential complications of prematurity that invariably accompany every article on the multiple births.

Although many people had never heard of fetal reduction until the birth of the McCaughey seven, the procedure has been in use for more than a decade. With the development of ultrasound and other prenatal tests, doctors could usually discover the number, positions, and often the health of babies in a multiple pregnancy. However, the mechanics of eliminating one or more unborn babies without endangering the mother, losing all the babies, or causing harm to the remaining baby or babies has been the major stumbling block.

Ironically, one of the first cases to gain media attention had nothing to do with the health of the mother or the number of babies, but rather with the termination of a baby with a disability in a twin pregnancy. In the 1980s, a mother threatened to abort the entire pregnancy if the twin with Down syndrome was not eliminated. This fetal reduction was hailed as a medical breakthrough when the “right” baby was delivered safely.

Several methods of fetal reduction have been used, including exsanguination (bleeding to death), injections of air, and suction abortion. The current method of preference involves using ultrasound to target the most accessible babies and inserting a long needle through the mother's abdomen and into the babies’ hearts. Next, a lethal dose of potassium chloride is injected to stop the heart and end the babies’ lives.

This abortion procedure is usually performed at nine to 13 weeks of gestation. The timing is important to ensure that the dead babies’ bodies dissolve and are reabsorbed. Besides reducing the risk of infection from dead tissue, reabsorption also has the advantage of sparing the mother— and the doctor—from seeing the results of the fetal reduction. A small number of such procedures are still selectively performed at 18 to 24 weeks, to eliminate unborn babies with abnormalities.

Occasionally doctors note an unusual complication: the “reduced” babies were found to be still alive upon later ultrasound. Even at nine weeks, some babies’ hearts are apparently so resilient that they restart on their own. Such occasions usually result in the doctors repeating the lethal injection until the targeted babies die.

Contrary to popular reports, the abortion procedure involves physical risks. Permanent damage to the surviving babies, infection, and premature labor are some of the potential complications that can occur with fetal reduction.

Rather than automatically ensuring the survival of the remaining babies, fetal reduction itself can cause miscarriage or premature birth. Estimates of the loss of all the surviving babies range from 7% to 22%. And, the larger the number of babies in the original pregnancy, the more likely a miscarriage, even after reduction, according to Dr. Mark Evans, a physician at Hutzel Hospital in Detroit, Mich.

Evans, a pioneer in fetal reduction, has analyzed data from physicians performing fetal reductions at six medical centers nationwide. He told the Electronic Times Union that approximately 40% of the mothers undergoing fetal reduction are carrying no more than triplets and that most mothers with multiple pregnancies reduce the number of babies to two.

Additionally, even though carrying twins is not considered risky, obstetricians are seeing a small but growing number of mostly older fertility patients seeking to reduce a twin pregnancy to a single one because of lifestyle or financial concerns. Dr. Evans sees no problems with even this: “If reducing from one to zero is acceptable in this society, then why not from two to one?” he asks.

That attitude, which considers any pregnancy disposable, is not universally shared by the women undergoing fetal reduction. These women and their husbands, who have invested so much emotion, energy, and money in their quest to conceive and finally reach their goal of becoming pregnant, experience great anguish when they feel they have to abort some of their babies.

The Nov. 21, 1997 issue of The Wall Street Journal recounted several poignant stories of women undergoing fetal reduction. A Florida woman who aborted one of her quadruplets said that even after two years she still struggles with her decision.

“There was never a moment when it felt right. My husband and I were bawling our eyes out during the whole thing,” she said.

Another mother agreed to undergo fetal reduction to eliminate one of her triplets with a reporter observing. But, afterwards, she wiped her tear-filled eyes and was unable to speak to the reporter at all. Yet another mother told of aborting two of her quadruplets only to lose the surviving twins in a premature birth—though she continued to defend her decision.

“I don't think it's fair having children that are premature and don't have a chance,” she insisted.

She is not alone. The birth of the McCaughey seven has sparked a national debate with some ethicists, doctors, and other commentators suggesting that, despite status of abortion as a legal right, parents like the McCaugheys are unnecessarily risking the lives of their babies and causing enormous health care costs when they reject fetal reduction.

Others, like Janet Bleyl, a mother of triplets and founder of Triplet Connection, and Dr. Ian MacIsaac of Australia who has spoken on the subject, feel that the dangers of multiple pregnancies are often exaggerated and used to scare patients into fetal reduction. After all, the successful delivery of quintuplets no longer makes national news.

The McCaugheys’ decision to reject fetal reduction because of their faith in God has also rankled some commentators. As columnist Richard Cohen wrote in the Nov. 25 Washington Post, “It has become commonplace in this country to use religion as an all-purpose excuse for not using your head.”

Franciscan Father Germain Kopaczynski, director of education at the Pope John Center for the Study of Ethics in Health Care in Boston, disagrees.

“Choosing some humans to die so others might live is putting into human hands a decision that shouldn't be made. It means you're playing God, but unfortunately, we don't play God as God plays God,” Father Kopaczynski told Catholic News Service.

In the end, McCaughey and the other women who refuse to abort any of their babies, seem to have much to teach doctors and other observers. The bottom line according to McCaughey is that “any child is a gift from God no matter whether it's one at a time or seven at a time.”

Nancy Guilfoy Valko, a registered nurse, is based in St. Louis, Mo.